Dermatomiositis juvenil

La dermatomiositis juvenil (DMJ) es una enfermedad multi sistémica de etiología desconocida, caracterizada por una vasculitis que ocasiona una inflamación no supurativa del músculo estriado y lesiones cutáneas distintivas. La cobertura de los criterios de Bohan y Peter establece el diagnóstico: exantema patognomónico junto a debilidad muscular proximal simétrica, elevación sérica de enzimas musculares, signos de inflamación, necrosis o ambas en biopsias del músculo y un electromiograma anormal. Un niño tiene dermatomiositis definida cuando además del exantema se cubren tres de los cuatro criterios, y sólo enfermedad probable cuando se cubren dos. Ante la sospecha de esta entidad se debe solicitar la valoración del paciente por un servicio de Reumatología Pediátrica, para su correcto diagnóstico y tratamiento.Juvenile dermatomyositis is a multisystemic disease of unknown etiology, characterized by vasculitis leading a non suppurative inflammation of the skeletal muscle and cutaneous findings. Bohan and Peeter' criteria's establish the diagnosis: characteristic rash associated with symmetric proximal muscle weakness, increase in serum muscle enzymes levels, an abnormal electromyography and inflammation signs, necrosis or both in muscle biopsies. Definitive dermatomyositis require the presence of 3 of 4 criteria associated with rash and probable disease with 2 criteria. Rheumatology consult must be performed with the suspicion of the disease to confirm the diagnosis and begin the treatment

Síndrome Ascítico edematoso

Se denomina síndrome ascítico edematoso (SAE) a la presencia de líquido libre en cantidad anormal en la cavidad peritoneal, asociada a expansión del líquido intersticial, causado por un aumento neto del contenido total de sodio y agua. Es secundario a un grupo muy heterogéneo de entidades clínicas

Prevalencia del tabaquismo pasivo en pediatría

Objetivo: estudiar la prevalencia de la exposición al humo de tabaco ambiental (HTA) de los niños asistidos durante el invierno del año 2007. Evaluar si la exposición al HTA se relaciona con determinada evolución en los pacientes internados por patología respiratoria. Material y método: se realizó un interrogatorio dirigido mediante un cuestionario escrito a los padres de 559 niños para determinar si los mismos estaban expuestos al HTA por padres, convivientes o cuidadores. Se los dividió en 4 grupos: Grupo 1: niños internados por patología respiratoria. Grupo 2: niños internados por patologías no respiratorias. Grupo 3: niños que consultaron ambulatoriamente al hospital. Grupo 4: niños que consultaron ambulatoriamente al sector privado. Se analizó en el grupo 1 a los niños cuya internación fue mayor a 10 días (internación prolongada) y a los que requirieron cuidados intensivos. Resultados: Grupo 1: 103 niños; grupo 2: 112 niños, grupo 3: 100 niños; grupo 4: 244 niños. La exposición al HTA fue: grupo 1, 77% (p=0.000); grupo 2, 52%; grupo 3, 50%; grupo 4, 33%. Al comparar los 2 grupos de pacientes internados, (1 y 2), observamos que la exposición al HTA fue significativamente mayor en el grupo 1 (p=0.0001). Al analizar los grupos de pacientes atendidos en forma ambulatoria en el sector publico (Grupo 3), y en el sector privado (Grupo 4), observamos que hubo una exposición al HTA significativamente mayor (p=0.002) en los pacientes del Grupo 3. El 90% de los niños que requirieron internación prolongada (17 de 19 niños) tenían antecedentes de exposición al HTA. El 80% de los que requirieron terapia intensiva (4 de 5 niños) estuvieron expuestos al HTA. Conclusiones: el grupo de pacientes internados por patología respiratoria fue el más expuesto a HTA. Además la mayoría de los pacientes con internación prolongada o que requirieron cuidados intensivos, presentaban como antecedente la exposición al HTA. Los niños que consultaron al sistema público presentaron mayor exposición al HTA que aquellos que lo hicieron al sistema privado.Objective: to study the prevalence of exposure to environmental tobacco smoke (ETS) of children assisted during the Winter of year 2007, and to evaluate if the exposure to ETS was related to a specific outcome in the group of patients hospitalized due of respiratory pathology

¡Alerta fiebre reumática!: a propósito de tres casos de Corea de Sydenham

La Corea de Sydenham (CS), manifestación mayor, tardía, frecuentemente única de la Fiebre Reumática (FR) y marcador de carditis, continúa afectando a nuestra población pediátrica pese a contar con los medios suficientes para evitarla. Presentamos tres casos de CS como manifestación de FR, con la presencia de carditis, atendidos en una sala de internación de un hospital público pediátrico en el lapso de los años 2014-2018. Es nuestra intención advertir a la comunidad médica sobre la importancia del tratamiento oportuno y completo de las faringitis estreptocócicas (grupos A, C y G) a fin de evitar la FR.Sydenham’s Chorea (SC) - a late, major manifestation, frequently the unique one of the Rheumatic Fever (RF), also indicator of a carditis- continues to affect our pediatric population in spite of having the necessary means to avoid it. We report three cases of SC as a manifestation of rheumatic fever, with the presence of carditis, which were admitted and attended in a public pediatric hospital between the years 2014-2018. It is our aim to warn the medical community about the importance of a suitable and thorough treatment of groups A-C-G streptococcalpharyngitis in order to avoid RF

Multicentre observational study on multisystem inflammatory syndrome related to COVID-19 in Argentina

Background: The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. Methods: This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. Results: Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. Conclusion: Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.Fil: Vainstein, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Baleani, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Urrutia, Luis. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Affranchino, Nicolás. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Ackerman, Judith. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Cazalas, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Goldsman, Alejandro. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Sardella, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Tolin, Ana Laura. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Goldaracena, Pablo. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Fabi, Mariana. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Cosentino, Mariana. Hospital Británico de Buenos Aires; ArgentinaFil: Magliola, Ricardo. Hospital Británico de Buenos Aires; ArgentinaFil: Roggiero, Gustavo. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Manso, Paula. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Triguy, Jésica. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Ballester, Celeste. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Cervetto, Vanesa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Vaccarello, María. Sanatorio de la Trinidad; ArgentinaFil: De Carli, Domingo Norberto. Clínica del Niño de Quilmes; ArgentinaFil: De Carli, Maria Estela. Clínica del Niño de Quilmes; ArgentinaFil: Ciotti, Ana Laura. Hospital Nacional Profesor Alejandro Posadas; ArgentinaFil: Sicurello, María Irene. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Rios Leiva, Cecilia. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Villalba, Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Hortas, María. Sanatorio de la Trinidad; ArgentinaFil: Peña, Sonia. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: González, Gabriela. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Zold, Camila Lidia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Murer, Mario Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Grippo, M.. No especifíca;Fil: Vázquez, H.. No especifíca;Fil: Morós, C.. No especifíca;Fil: Di Santo, M.. No especifíca;Fil: Villa, A.. No especifíca;Fil: Lazota, P.. No especifíca;Fil: Foti, M.. No especifíca;Fil: Napoli, N.. No especifíca;Fil: Katsikas, M. M.. No especifíca;Fil: Tonello, L.. No especifíca;Fil: Peña, J.. No especifíca;Fil: Etcheverry, M.. No especifíca;Fil: Iglesias, D.. No especifíca;Fil: Alcalde, A. L.. No especifíca;Fil: Bruera, M.J.. No especifíca;Fil: Bruzzo, V.. No especifíca;Fil: Giordano, P.. No especifíca;Fil: Pena Acero, F.. No especifíca;Fil: Netri Pelandi, G.. No especifíca;Fil: Pastaro, D.. No especifíca;Fil: Bleiz, J.. No especifíca;Fil: Rodríguez, M. F.. No especifíca;Fil: Laghezza, L.. No especifíca;Fil: Molina, M. B.. No especifíca;Fil: Patynok, N.. No especifíca;Fil: Chatelain, M. S.. No especifíca;Fil: Aguilar, M. J.. No especifíca;Fil: Gamboa, J.. No especifíca;Fil: Cervan, M.. No especifíca;Fil: Ruggeri, A.. No especifíca;Fil: Marinelli, I.. No especifíca;Fil: Checcacci, E.. No especifíca;Fil: Meregalli, C.. No especifíca;Fil: Damksy Barbosa, J.. No especifíca;Fil: Fernie, L.. No especifíca;Fil: Fernández, M. J.. No especifíca;Fil: Saenz Tejeira, M.M.. No especifíca;Fil: Cereigido, C.. No especifíca;Fil: Nunell, A.. No especifíca;Fil: Villar, D.. No especifíca;Fil: Mansilla, A. D.. No especifíca;Fil: Darduin, M. D.. No especifíca

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Descripción epidemiológica de la patología social y de salud mental en una sala de internación clínica de un hospital público especializado en pediatría

Introducción: En la actualidad, existe un notable incremento en las patologías relacionadas con problemáticas sociales y de salud mental. La problemática social da cuenta de la existencia de situaciones familiares que ponen en riesgo a los niños, como situaciones de maltrato, violencia u omisión de cuidados de los mismos. Los problemas de salud mental hacen referencia a niños que padecen desordenes mentales que los llevan a la psicosis, intentos de suicidio, depresión, o trastornos del ánimo y del humor. Estas patologías son susceptibles de comorbilidades clínicas como la obesidad ya que las características familiares, las psiquiátricas y los aspectos psicológicos, entre ellos la ansiedad, han sido descritos en la producción y mantenimiento de la misma. Objetivo: Describir las características epidemiológicas de pacientes hospitalizados en una sala de internación general del Hospital de Niños Sor María Ludovica de La Plata con problemática en cuanto a patología Social y de Salud mental, durante un periodo de 18 meses. Material y métodos: Estudio descriptivo retrospectivo. Se analizaron 61 historias clínicas de ingresos por patología de salud mental y problemática social en la sala 3 de Clínica Pediátrica durante un periodo de 18 meses. Resultados: El 78,6% fueron de sexo femenino y el 80 % mayores de 10 años. La mayoría provenía del Gran La Plata (90%). El 85% ingresaron en buen estado general o alcanzaron la estabilidad clínica en las primeras 72 horas de internación. Estas internaciones fueron prolongadas comparadas con el promedio de internación hospitalaria general. En ellas intervinieron múltiples servicios (promedio de 3 servicios por paciente y de 2 a 6 interconsultas). En un porcentaje importante (88%) se caracterizó a la familia como disfuncional o de riesgo. Conclusión: Se evidenció un predominio de hospitalizaciones por cuestiones sociales o de salud mental en pacientes de sexo femenino y del grupo de adolescentes. Los diagnósticos clínicos de ingreso se superpusieron a la problemática social y de salud mental demostrando la complejidad de estas patologías y la necesidad del trabajo interdisciplinario.Introduction: Currently, there is a notable increase in pathologies related to social problems and mental health. The social problem accounts for the existence of family situations that put children at risk, such as situations of abuse, violence or lack of care for them. Mental health problems refer to children who suffer from mental disorders that lead to psychosis, suicide attempts, depression, or mood and mood disorders. These pathologies are susceptible to clinical comorbidities such as obesity since family characteristics, psychiatric and psychological aspects, including anxiety, have been described in its production and maintenance. Objectives: To describe the epidemiological characteristics of patients hospitalized in a general hospitalization room of the Sor María Ludovica Children’s Hospital of La Plata with problems in terms of Social pathology and mental health, during a period of 18 months. Material and methods: Descriptive-retrospective study. 61 medical records of admissions for mental health pathology and social problems were analyzed in room 3 of Clínica Pediátrica during a period of 18 months. Results: 78.6% were female and 80% were older than 10 years. The majority came from Gran La Plata (90%). 85% were admitted in good general condition or achieved clinical stability in the first 72 hours of hospitalization. These hospitalizations were prolonged compared to the average general hospital stay. They involved multiple services (average of 3 services per patient and 2 to 6 interconsultations). In a significant percentage (88%) the family was characterized as dysfunctional or with social risk. Conclusion: A predominance of hospitalizations for social or mental health issues was evidenced in female patients and in the adolescent group. The admission diagnoses were superimposed on the social and mental health problems, demonstrating the complexity of these pathologies and the need for interdisciplinary work

Liver Transplantation without Perioperative Transfusions Single-Center Experience Showing Better Early Outcome and Shorter Hospital Stay

Background. Significant amounts of red blood cells (RBCs) transfusions are associated with poor outcome after liver transplantation (LT). We report our series of LT without perioperative RBC (P-RBC) transfusions to evaluate its influence on early and long-term outcomes following LT. Methods. A consecutive series of LT between 2006 and 2011 was analyzed. P-RBC transfusion was defined as one or more RBC units administrated during or ≤48 hours after LT. We divided the cohort in “No-Transfusion” and “Yes-Transfusion.” Preoperative status, graft quality, and intra- and postoperative variables were compared to assess P-RBC transfusion risk factors and postoperative outcome. Results. LT was performed in 127 patients (“No-Transfusion” = 39 versus “Yes-Transfusion” = 88). While median MELD was significantly higher in Yes-Transfusion (11 versus 21; P=0.0001) group, platelet count, prothrombin time, and hemoglobin were significantly lower. On multivariate analysis, the unique independent risk factor associated with P-RBC transfusions was preoperative hemoglobin (P<0.001). Incidence of postoperative bacterial infections (10 versus 27%; P=0.03), median ICU (2 versus 3 days; P=0.03), and hospital stay (7.5 versus 9 days; P=0.01) were negatively influenced by P-RBC transfusions. However, 30-day mortality (10 versus 15%) and one- (86 versus 70%) and 3-year (77 versus 66%) survival were equivalent in both groups. Conclusions. Recipient MELD score was not a predictive factor for P-RBC transfusion. Patients requiring P-RBC transfusions had worse postoperative outcome. Therefore, maximum efforts must be focused on improving hemoglobin levels during waiting list time to prevent using P-RBC in LT recipients